Risk and protective factors for meningococcal disease in adolescents: matched cohort study

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:445
  1. Joanna Tully, clinical research fellow1,
  2. Russell M Viner, consultant in adolescent medicine and endocrinology2,
  3. Pietro G Coen, statistician1,
  4. James M Stuart, consultant epidemiologist4,
  5. Maria Zambon, head of respiratory virus unit5,
  6. Catherine Peckham, professor of paediatric epidemiology3,
  7. Clare Booth, research assistant6,
  8. Nigel Klein, professor of infectious diseases and immunology6,
  9. Ed Kaczmarski, director7,
  10. Robert Booy, professor of academic child health (robertb2{at}
  1. 1 Academic Centre for Child Health, Queen Mary's School of Medicine and Dentistry at Barts and the London, University of London, London E1 1BB
  2. 2 Department of Paediatrics, Royal Free and University College Medical School, University College, London WC1E 6BT
  3. 3 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 3JH
  4. 4 Health Protection Agency (South West), Stonehouse GL10 3RF
  5. 5 Health Protection Agency, Respiratory Virus Unit, Health Protection Agency, London NW9 5HT
  6. 6 Infectious Diseases and Microbiology Unit, Institute of Child Health
  7. 7 Health Protection Agency, Meningococcal Reference Unit, Manchester Royal Infirmary, Manchester M13 9WZ
  1. Correspondence to: R Booy
  • Accepted 14 November 2005


Objective To examine biological and social risk factors for meningococcal disease in adolescents.

Design Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner.

Setting Six contiguous regions of England, which represent some 65% of the country's population.

Participants 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls.

Methods Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression.

Results 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection.

Conclusions Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority.


  • Contributors JT coordinated the study and drafted the manuscript. PGC was primarily responsible for data cleaning and analysis and contributed to manuscript revisions. JMS, MZ, CP, and EK contributed to study design, analysis, and manuscript revisions. CB and NK analysed genetic data and contributed to manuscript revisions. MZ was also responsible for laboratory analysis of viral data. RMV and RB designed the study, analysed data, and revised the manuscript. RB is guarantor.

  • Funding Meningitis Research Foundation, UK; in addition, the Wolfson Foundation provided an equipment grant. RMV is supported by the Health Foundation.

  • Competing interests RB has acted as a paid consultant for Wyeth, GlaxoSmithKline, and Aventis Pasteur. MZ has received honoraria from Berna Biotech to speak at industry conferences on influenza. The UK Health Protection Agency has received funding from Chiron vaccines, Wyeth vaccines, Aventis Pasteur, Roche, and GlaxoSmithKline to carry out analytical work on a contractual basis in MZ's laboratory.

  • Ethical approval North Thames multicentre research ethics committee and 125 local research ethics committees.

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